Healthier side dishes at restaurants: an analysis of children's perspectives, menu content, and energy impacts

Abstract

Background: Children consume restaurant-prepared foods at high rates, suggesting that interventions and policies targeting consumption of these foods have the potential to improve diet quality and attenuate excess energy intake. One approach to encouraging healthier dietary intake in restaurants is to offer fruits and vegetables (FV) as side dishes, as opposed to traditional, energy-dense accompaniments like French fries. The aims of the current study were to examine: children's views about healthier side dishes at restaurants; current side dish offerings on children's menus at leading restaurants; and potential energy reductions when substituting FV side dishes in place of French fries.

Methods: To investigate children's attitudes, a survey was administered to a nationally representative sample of U.S. 8- to 18-year-olds (n = 1178). To examine current side dish offerings, children's menus from leading quick service (QSR; n = 10) and full service restaurant chains (FSR; n = 10) were analyzed. Energy reductions that could result from substituting commonly-offered FV side dishes for French fries were estimated using nutrition information corresponding to the children's menu items.

Results: Two-thirds of children reported that they would not feel negatively about receiving FV sides instead of French fries with kids' meals. Liking/taste was the most common reason that children gave to explain their attitudes about FV side dishes. Nearly all restaurants offered at least 1 FV side dish option, but at most restaurants (60% of QSR; 70% of FSR), FV sides were never served by default. Substituting FV side dishes for French fries yielded an average estimated energy reduction of at least 170 calories.

Conclusions: Results highlight some healthy trends in the restaurant context, including the majority of children reporting non-negative attitudes about FV side dishes and the consistent availability of FV side dish options at leading QSR and FSR. Yet the minority of restaurants offer these FV sides by default. Promoting creative, appealing FV side dishes can result in healthier, less energy-dense meals for children. Substituting or displacing energy-dense default side dishes with such FV dishes show promise as part of continued, comprehensive efforts to increase the healthfulness of meals consumed by children in restaurant settings.

Figure 1

Categorization of children’s open-ended responses explaining why they would be happy or unhappy if their kid’s meal came with a fruit/vegetable instead of French fries. One-third of children reported that they would be happy or somewhat happy, and these children are included in the left panel. One-third of children reported that they would be unhappy or somewhat unhappy, and these children are included in the right panel. For the children who would be happy if their kid’s meal came with a fruit/vegetable instead of French fries, the most common reasons were related to liking/taste (of fruits/vegetables; 57.1%) and health (41.9%). For the children who would be unhappy if their kid’s meal came with a fruit/vegetable instead of French fries, liking/taste (of French fries) was the most common reason (77.4%). Children's coded, open-ended responses could fall into more than one category, and category descriptions are in Table 1. Note: * = significant age group difference at p < .05.

Figure 2

Prevalence of side dish offerings on children’s menus at quick service (QSR) and full service restaurants (FSR). The prevalence of fruit and vegetable (FV) and non-FV side dishes across children’s menus at the top 10 QSR and top 10 FSR are shown. FV sides consist of all non-fried FV and include legumes. Non-FV sides include all other sides, such as French fries, rice, and biscuits. The solid black blocks represent the prevalence of non-FV side dish options. Together, the remaining blocks show the overall prevalence of FV side dishes, and they are divided to further illustrate the specific FV side dishes available. The most common FV side dish items are depicted individually, and less common items are collapsed into “Other Fruits” (applesauce, grapes, pineapple, berries) and “Other Vegetables” (green beans, celery, mixed vegetables, cole slaw, other beans, greens). Full service restaurants had more variability among their FV side dish items, compared to QSR.